Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia

Joseph T. Hanlon, Sherrie L. Aspinall, Steven M. Handler, Walid F. Gellad, Roslyn A. Stone, Todd P. Semla, Mary Jo V Pugh, Maurice W. Dysken

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Original languageEnglish
Pages (from-to)20-28
Number of pages9
JournalAnnals of Pharmacotherapy
Volume49
Issue number1
DOIs
StatePublished - Jan 20 2015
Externally publishedYes

Fingerprint

Veterans
Nursing Homes
Dementia
Cholinesterase Inhibitors
Drug Interactions
Pharmaceutical Preparations
Drug-Related Side Effects and Adverse Reactions
Antipsychotic Agents
Retrospective Studies
Logistic Models
Regression Analysis
Lipids

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Hanlon, J. T., Aspinall, S. L., Handler, S. M., Gellad, W. F., Stone, R. A., Semla, T. P., ... Dysken, M. W. (2015). Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia. Annals of Pharmacotherapy, 49(1), 20-28. https://doi.org/10.1177/1060028014558484

Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia. / Hanlon, Joseph T.; Aspinall, Sherrie L.; Handler, Steven M.; Gellad, Walid F.; Stone, Roslyn A.; Semla, Todd P.; Pugh, Mary Jo V; Dysken, Maurice W.

In: Annals of Pharmacotherapy, Vol. 49, No. 1, 20.01.2015, p. 20-28.

Research output: Contribution to journalArticle

Hanlon, JT, Aspinall, SL, Handler, SM, Gellad, WF, Stone, RA, Semla, TP, Pugh, MJV & Dysken, MW 2015, 'Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia', Annals of Pharmacotherapy, vol. 49, no. 1, pp. 20-28. https://doi.org/10.1177/1060028014558484
Hanlon JT, Aspinall SL, Handler SM, Gellad WF, Stone RA, Semla TP et al. Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia. Annals of Pharmacotherapy. 2015 Jan 20;49(1):20-28. https://doi.org/10.1177/1060028014558484
Hanlon, Joseph T. ; Aspinall, Sherrie L. ; Handler, Steven M. ; Gellad, Walid F. ; Stone, Roslyn A. ; Semla, Todd P. ; Pugh, Mary Jo V ; Dysken, Maurice W. / Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia. In: Annals of Pharmacotherapy. 2015 ; Vol. 49, No. 1. pp. 20-28.
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title = "Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia",
abstract = "Background: Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. Objective: To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. Methods: This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. Results: Overall, 70.2{\%} with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2{\%} had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36.1{\%} had overuse by receiving an AChEI or lipid-lowering or other agents, and 25.1{\%} had evidence of inappropriate use as a result of a drug-disease or drug-drug interaction. Multinomial logistic regression analyses among those with mild to moderate dementia identified that living in the South versus other regions was the single factor associated with all 3 types of suboptimal prescribing. In those with severe dementia, antipsychotic use was associated with all 3 suboptimal prescribing types. Conclusions: Potentially suboptimal prescribing was common in older veteran nursing home patients with dementia. Clinicians should develop a heightened awareness of these problems. Future studies should examine associations between potentially suboptimal prescribing and health outcomes in patients with dementia.",
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AU - Aspinall, Sherrie L.

AU - Handler, Steven M.

AU - Gellad, Walid F.

AU - Stone, Roslyn A.

AU - Semla, Todd P.

AU - Pugh, Mary Jo V

AU - Dysken, Maurice W.

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N2 - Background: Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. Objective: To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. Methods: This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. Results: Overall, 70.2% with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2% had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36.1% had overuse by receiving an AChEI or lipid-lowering or other agents, and 25.1% had evidence of inappropriate use as a result of a drug-disease or drug-drug interaction. Multinomial logistic regression analyses among those with mild to moderate dementia identified that living in the South versus other regions was the single factor associated with all 3 types of suboptimal prescribing. In those with severe dementia, antipsychotic use was associated with all 3 suboptimal prescribing types. Conclusions: Potentially suboptimal prescribing was common in older veteran nursing home patients with dementia. Clinicians should develop a heightened awareness of these problems. Future studies should examine associations between potentially suboptimal prescribing and health outcomes in patients with dementia.

AB - Background: Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. Objective: To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. Methods: This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. Results: Overall, 70.2% with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2% had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36.1% had overuse by receiving an AChEI or lipid-lowering or other agents, and 25.1% had evidence of inappropriate use as a result of a drug-disease or drug-drug interaction. Multinomial logistic regression analyses among those with mild to moderate dementia identified that living in the South versus other regions was the single factor associated with all 3 types of suboptimal prescribing. In those with severe dementia, antipsychotic use was associated with all 3 suboptimal prescribing types. Conclusions: Potentially suboptimal prescribing was common in older veteran nursing home patients with dementia. Clinicians should develop a heightened awareness of these problems. Future studies should examine associations between potentially suboptimal prescribing and health outcomes in patients with dementia.

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